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Uploaded byRichmond Stace MCSP MSc (Pain) BSc (Hons)
Queen Mary's University London | SEM 2016
This document discusses pain in the context of sport. It notes that pain is a complex experience influenced by biological and psychological factors. It is not always indicative of actual tissue damage. When an injury occurs, many individual factors like a person's health history, mindset, and early treatment can influence whether the pain persists long-term. Managing persisting pain involves seeing the whole person, understanding pain scientifically, and using rehabilitation to restore normal function and a positive self-identity, rather than just focusing on pain alone.
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Queen Mary's University London | SEM 2016
- 1. Pain in sport RichmondM. Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist
- 2. Behind every pain… …isa story …a person Know the person to know the pain It’s as much about the person as the condition – Oliver Sacks When a person is better, the pain is better People with persisting pain often fall in the cracks
- 3. Picture this.. 16 yearold sporty girl with shin pain 2 years and worsening Continues to play sport most days at school Very tender to touch Sometimes very painful to walk First thoughts?
- 4. Then…. 8 year h/omigraines Digestive disturbances Disturbed sleep Widespread tenderness Perfectionist & demanding school This a case for……
- 5. A lack ofsigns? Puzzling? Is there an actual injury? Is there sensitivity? e.g./ hamstring ‘re-injury’ What’s the story? is there damage or does it just feel like damage?
- 6. Acute pain Isit an injury? “I sincerely thought it was the last ball I would be touching for a long time because of the pain”. Messi (2012)
- 7. Acute injury Isthere actual damage? Does more damage = more pain?
- 8. Pain is… Normal Part ofprotection Important for survival Unpleasant A motivator compelling action
- 9. Pain definition IASP An unpleasantsensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- 10. Pain is theNo.1 global health burden Back pain, neck pain, headache, migraine, OA All in top 12 depression Persisting pain What do you think about? Is persisting pain in sport?
- 11. The problem Pain misunderstood Society Healthcare Wrongmessages communicated Low expectations Even morphine affected by expectation Poor outcomes
- 12. Persisting pain insport Yes How common? Impact – this is the ‘lived experience’ Person Professional vs amateur Participation Performance Playing with pain
- 13. What can wedo? Develop understanding of pain Answer the question: what is pain really? This answer leads to a route onwards Different thinking Neurobiology Neuroimmunobiology neuroimmunoendobiology
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- 15. What is anyexperience? The brain’s best guess! Making sense of the world now Generates & constructs explanations for its sensory input Generates predictions of sensations Generates hypotheses to try to explain what is happening in the outside world
- 16. Mature organism model(Gifford)
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- 18. Change We change ‘Neuroplasticity’ Which direction? There’s more than one direction If you think there is… Your choice
- 19. Whole person ‘I’think ‘I’ feel (pain, thirst, hunger) My ______ does not feel pain, I do What do we treat? Or who do we treat?
- 20. Embodied cognition The bodyan extension of the mind We are more than a brain Our bodies in the world do much of the work needed to achieve goals (not just the brain) e.g mechanics of walking Gestures reduce load on brain I think with my whole person Where do you feel anxious? Hungry?
- 21. Embodied athletes Identify withbody & performance Their sense of self encompasses body & performance ‘gestures’ part of their cognition Automatic Predictions not responses – otherwise miss the ball! Injury => loss of sense of self
- 22. Pain Consider… Painis a lived experience Pain is not an accurate indicator of tissue damage Pain is about perceived threat Pain is allocated a space Pain is dynamic
- 23. What influences pain? The meaning – what do you tell yourself? The context Where you are What you are doing What you are planning to do What you have just done Emotional state – anxiety, stress Tiredness Prior experience Beliefs about pain/health Attention bias Who we are with
- 24. Pain in sport Expected Part of training & playing Accepted risk ‘no pain, no gain’ What if the pain persists…… or injuries recur?
- 25. New injury Whatdo you want to know?
- 26. The injury moment Context Mechanism Meaning Body responses Pain intensity Current health Early care Initial management Messages given Investigations Other’s responses Facial Verbal
- 27. Injury – notin isolation Why? Pain vulnerabilities Pre-existing sensitivity Functional pain syndromes Injury patterns Fatigue Health Prior injuries & pain Circumstances The person Priming factors Pain vulnerability Genetics Body sense e.g. hypermobility
- 28. Persisting pain Begins atthe moment of injury Vulnerable Uncontrolled pain Wrong treatment Pain beyond a useful time? Or are there health issues? Habits of thought and action
- 29. What have youseen? Features?
- 30. What do wesee? Loss of sense of self Change in body sense Altered movement patterns Altered thinking Outlook? Altered planning Change in perception of the environment Sickness responses Other aches and pains Poor sleep Varied emotions
- 31. What are wetrying to do? Restore a sense of self as defined by the person Resume a meaningful life Matching what is expected with what is happening What does that look like? Ask the person? Their vision
- 32. How do wedo it? Working knowledge of pain Reduce threat Take healthy action Develop body sense Sensorimotor training Motor imagery visualisation Focus on health (not pain) What we focus on, we get more of… Deal with distractions from the vision Programme must be lived Moment to moment Build tolerance for activities Graded exposure General fitness Sleep habit Meet basic needs! Pain Coach Strengths based coaching Become their own coach
- 33. Key points Pain iswhole person: when the person gets better, the pain gets better Early messages are key! Understanding pain is vital – working knowledge Pain is a lived experience, which the programme must reflect Pain is temporary, each moment unique Change is certain; direction can be a choice
- 34. Thanks! @painphysio www.specialistpainphysio.com [email protected] 07932 689081 UP |understand pain – www.understandpain.com @upandsing